比较 HPV 阳性口咽鳞状细胞癌的标准剂量放疗与降低放疗剂量在确定性治疗中的作用。
Radiation therapy dose de-escalation compared to standard dose radiation therapy in definitive treatment of HPV-positive oropharyngeal squamous cell carcinoma.
机构信息
Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States.
Saint Louis University School of Medicine, Saint Louis, United States.
出版信息
Radiother Oncol. 2019 May;134:81-88. doi: 10.1016/j.radonc.2019.01.016. Epub 2019 Feb 4.
BACKGROUND
Despite existing evidence that human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has a favorable prognosis compared to HPV-negative OPSCC, randomized studies have yet to report the effect of de-escalating radiation therapy (RT) dose for definitive treatment. The aim of this study was to assess the effectiveness of dose de-escalated RT (DDRT) vs. standard dose RT (SDRT) in patients with HPV-positive OPSCC.
METHODS
This was an observational study using the National Cancer Database (Year 2010-2014) to identify patients who had HPV-positive OPSCC and were treated with definitive RT or chemo-RT. Patients undergoing surgery were excluded. Patients receiving ≥50 Gy, but <66 Gy were categorized as receiving DDRT. Patients receiving ≥66 Gy were categorized as receiving SDRT. Inverse probability of treatment weighting (IPTW) using propensity scores was used to balance the two groups. Kaplan-Meier analysis was used to estimate overall survival (OS). Subset analyses in patients receiving RT alone and concurrent chemo-RT were also performed. Multivariable Cox proportional hazards modeling was used to evaluate factors associated with OS.
RESULTS
759 patients with HPV-positive OPSCC were identified: 104 received DDRT and 655 received SDRT. The median follow-up was 30.5 (2.4-81.4) months. After IPTW-adjusted analysis, there was no difference in the 3-yr OS between the two groups (82.2% vs. 79.3%; P = 0.85). In the subset of patients receiving concurrent chemoradiotherapy, IPTW-adjusted analysis also did not show a difference in the 3-yr OS between the two groups (83.1% vs. 79.6%; P = 0.83). On multivariable analysis, DDRT was not associated with an inferior OS (HR 0.88; 95% CI, 0.53-1.47; P = 0.63).
CONCLUSIONS
In this study, DDRT was not associated with an inferior OS compared to SDRT in patients with HPV-positive OPSCC. Randomized clinical trials to address DDRT in this patient population are currently ongoing.
背景
尽管现有证据表明，与 HPV 阴性口咽鳞状细胞癌（OPSCC）相比，人乳头瘤病毒（HPV）阳性 OPSCC 的预后较好，但随机研究尚未报告为明确治疗而降低放射治疗（RT）剂量的效果。本研究旨在评估 HPV 阳性 OPSCC 患者接受剂量递减 RT（DDRT）与标准剂量 RT（SDRT）治疗的效果。
方法
这是一项使用国家癌症数据库（2010-2014 年）的观察性研究，旨在确定接受明确性 RT 或放化疗的 HPV 阳性 OPSCC 患者。排除接受手术的患者。接受≥50Gy，但<66Gy 的患者被归类为接受 DDRT。接受≥66Gy 的患者被归类为接受 SDRT。使用倾向评分进行逆概率治疗加权（IPTW）以平衡两组。Kaplan-Meier 分析用于估计总生存率（OS）。还对单独接受 RT 和同步放化疗的患者进行了亚组分析。多变量 Cox 比例风险模型用于评估与 OS 相关的因素。
结果
确定了 759 例 HPV 阳性 OPSCC 患者：104 例接受 DDRT，655 例接受 SDRT。中位随访时间为 30.5（2.4-81.4）个月。在 IPTW 调整分析后，两组 3 年 OS 无差异（82.2%vs.79.3%；P=0.85）。在接受同步放化疗的患者亚组中，IPTW 调整分析也未显示两组 3 年 OS 存在差异（83.1%vs.79.6%；P=0.83）。多变量分析显示，DDRT 与较差的 OS 无关（HR 0.88；95%CI，0.53-1.47；P=0.63）。
结论
在这项研究中，与 SDRT 相比，HPV 阳性 OPSCC 患者接受 DDRT 治疗与较差的 OS 无关。目前正在进行针对该患者人群的 DDRT 随机临床试验。
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